前言

前言 过去十年间，对慈悲心的科学研究兴趣日益浓厚。考虑到佛教在2500多年前就曾主张培养慈悲心是自我和他人幸福的关键，有人可能会说“是时候了”！然而，威廉·图克（William Tuke）在1796年创立了约克休养所（York Retreat），并有意识地试图创造一个充满同情心和支持的环境。医学史学家罗伊·波特（Roy Porter）（2002年）说：“图克的孙子塞缪尔（Samuel）曾指出，最初在那里尝试过一些医疗疗法，但收效甚微；然后休养所放弃了‘医疗’手段，转而采用‘道德’手段，即仁慈、温和、理性和人性，所有这些都在家庭氛围中进行——结果非常好。”（第104页） 然而，直到最近，慈悲心在心理治疗中的科学关注度并不高。尽管卡尔·罗杰斯（Carl Rogers）基于同理心和积极关注确定了治疗关系的核心要素，但“充满同情心的治疗关系”这一概念一直比较模糊，而有意识地培养对患者自身和他人的同情心作为治疗目标则是全新的（吉尔伯特，2009a，2010）。弗洛伊德学派早期的心理动力学理论主要关注人性阴暗的一面——性与暴力——而同情心只是这些阴暗面的升华（Kriegman, 1990, 2000）。行为主义者对恐惧的暴露感兴趣，认知疗法则热衷于帮助我们解决非理性思维问题。然而，如今的心理治疗师开始重新审视同情的概念及其治疗潜力。部分原因是同情已获得科学认可。这在很大程度上受到神经科学家与达赖喇嘛合作，研究人们在练习同情时大脑发生的变化（Lutz, Brefczynski-Lewis, Johnstone， & Davidson, 2008）的启发。将同情融入治疗的第二个主要动力来自越来越多地认识到依恋的进化本质和重要性，这种能力使父母能够敏感地感知婴儿的痛苦，并有能力对这种压力做出回应，使婴儿能够对这种关怀做出回应（Mikulincer & Shaver, 2007b）。第三个影响因素是越来越多的证据表明，亲社会行为、情感和同情心在大脑中是相互关联的（Baumeister, 1998; Decety & Jack, 2005; Eisenberg, 1995; Keenan & Gzendy, 2005; Zaki & Ochsner, 2011）。社会支持、归属感和与他人的联系都对心理健康（Cacioppo & Patrick, 2008）和许多生理过程（Cozolino, 2007）产生重大影响，包括基因表达（Slavich & Cole, 2013）。事实上，现在有充分的证据表明，当人们感到被重视、被爱和被关心时，他们就能发挥出最佳状态，反过来也能对他人给予重视和关爱（Gilbert & Choden, 2013）。因此，社交关系是幸福的核心，令人惊讶的是，心理治疗师在研究社交情感的产生、分享和治愈过程方面进展如此缓慢。

与此同时，越来越多的研究开始关注亲社会行为和同情心，许多疗法开始思考同情心的性质和治疗潜力。因此，接受和承诺疗法（ACT）作为心理学治疗的新兴主要学派之一，开始考虑同情心在其自身语境下的性质和价值，这恰逢其时。ACT一直将治疗关系视为核心。治疗旅程（Pierson & Hayes, 2007），但最近才开始关注同情本身。因此，对于ACT治疗师来说，有什么比Drs. Dennis Tirch、Laura Silberstein和Benjamin Schoendorff更好的向导，来开始同情之旅呢？Tirch博士不仅是经验丰富的、世界公认的ACT治疗师，他还接受过以同情为中心的治疗（CFT；Gilbert 2009a, 2010）的培训，并多年来参与佛教实践。他创立了The Compassionate Mind Foundation USA（http：//www.compassionfocusedtherapy.com）和The Center for Mindfulness and CFT（http：//www.mindfulcompassion.com），这两个组织都致力于在北美进一步培训、研究和发展CFT。Schoendorff博士是ACT和功能分析心理治疗（FAP）的国际知名专家和培训师，他强调在心理治疗关系中培养自我同情。约翰逊博士 西尔伯斯坦是心理灵活性中情感作用方面的专家，在职业生涯中一直致力于研究、实践和撰写将CFT（接受与承诺疗法）、佛学心理学和ACT（接受与承诺疗法）整合在一起的内容。这些作者以其独特的学术和智慧为读者提供了关于ACT、FAP（功能分析心理学）和CFT等不同模型的重要见解，并提出了富有创新性的想法，即如何将这些方法整合起来，将同情心融入治疗重点。

同情很容易被误解，与爱和善良混淆。 事实上，最困难但最有力量的同情形式是对我们既不爱也不喜欢的事物，这包括我们自己的某些方面。在大乘佛教传统中，达赖喇嘛是其中最有影响力的倡导者之一，同情的核心是动机——为他人谋利益的动机，称为菩提心。这种动机是培养自己对自身和他人痛苦的敏感性和注意力，能够洞察痛苦的原因，并获得智慧和承诺，试图减轻和预防痛苦。显然，这里包含了朝向痛苦、进入痛苦之风，而不是远离它的动机；培养愿意与痛苦及其原因接触的意愿。在这里，我们看到了与ACT的直接共鸣，自创立以来，ACT优雅地关注了情感回避问题，并培养了愿意以事物本来面貌体验事物的意愿。然而，更重要的是，在CFT和ACT中，同情被作为一种治疗重点，不仅用于缓解痛苦，还用于促进个人成长和自我实现。这也是为什么CFT非常关注依恋和亲社会行为的深层动态的原因之一。将同情作为治疗的焦点必须是为了促进幸福，而不仅仅是减少痛苦。虽然CFT试图阐明同情的一些关键要素，比如以关怀为导向的动机、注意力敏感性、同情心、忍受痛苦的能力、共情和无条件判断，并帮助人们培养这些品质，但ACT则更关注帮助人们从心灵编织的纠缠中解脱的原则。这些纠缠的产生是因为除了与动物共享的基本动机和情感之外，大约200万年前，人类进化出了想象力、沉思、自我意识和自我监控的能力。ACT关注的是这些新进化出的认知能力如何与较老的情感动机系统整合和融合。帮助人们摆脱与痛苦情绪紧密结合的负面自我监控和自我标签是至关重要的，ACT称之为心理灵活性。像同情心一样，这个概念也不是一个简单的概念；这确实是一系列子过程的结果，比如解离、价值观、自我作为背景、接纳、承诺行动和觉知。因此，特里奇、舍恩多夫和西尔伯斯坦决定考虑慈悲和心理灵活性这些不同的过程之间是如何相互关联的，以及从对方的角度来看，如何考虑每一个过程。时间 目的不是将一种模型简化为另一种模型，而是阐明ACT如何用自己的术语来处理同情的现象学。结果是一种创新且发人深省的叙事，关于培养同情心的新方法，或者至少是创造同情心产生的条件。因此，如果ACT从业者想要思考如何在ACT术语中将同情心置于中心位置，这里是一种方法。

CFT认为，同情的治疗效果植根于特定的心理状态，这些状态会招募与依恋、利他主义和关怀行为共同进化的核心生理系统（Gilbert, 2009a）——催产素和副交感神经系统的髓鞘状迷走神经是其中的两个系统。因此，CFT涉及呼吸训练、正念、想象力和身体聚焦工作。CFT还使用方法演技技巧来练习“假装……”，并想象自己是一个有同情心的人（Gilbert, 2010），这有助于客户围绕同情的核心特质建立自我身份。

这种自我意识随后就成为焦点——用依恋术语来说就是“安全基地”和“安全港”——从中我们可以与痛苦接触。

ACT从行为研究中汲取理论养分，并不依赖于依恋理论，也不关注可能产生平静、明智、亲社会的心态的特定潜在生理机制。尽管ACT也认为同情植根于古老的进化心理系统，但它将进化的重点放在合作而非关怀上。对于ACT来说，合作的优势创造了进化压力，增强了人类合作的能力。显然，其中一些优势包括口头交流和开放用于世界象征的语言。因此，词汇和符号成为标志，使人们能够分享知识、概念和学习。但是，所有这些都无法在人们没有彼此的基本兴趣、分享的愿望和分享的快乐的情况下出现。在ACT中，人类语言的进化和它所允许的象征性和口头表达开启了融合之门；也就是说，象征性和口头表达可以与一个人的自我感融合。相比之下，一只受到威胁的猴子不会产生这种融合。主导者和服从者之间如果缺乏语言或符号的交流，就无法开始思考自己处于劣势或从属地位，也无法考虑这种经历对其生活和与其他猴子的关系所产生的影响——实际上，他们无法从这个意义上拥有自我意识。因此，正如你所看到的，这本书对“言语标签”的概念给予了特别的关注，因为这是人类独有的能力。

这在CFT中并非不重要，但相对而言并不那么重要，因为CFT更关注直接经验，并对“头脑中的情感场景”和与自卑感相关的情感记忆感兴趣，而不是它们的言语标签。例如，在羞耻感的例子中：如果父母对孩子生气，孩子会将自我的记忆（条件性情感学习）编码为刺激他人愤怒的行为。这被编码为“情感场景”，而这样的情感场景将成为后续自我定义的基础。因此，一个经历过父母的愤怒（可能还对他们进行了言语上的贬低或责备）的人可能会谈论自己感觉不够好或容易受到批评。但实际上关键在于，他们这表明“在我的情感记忆中，我曾经体验过自己是不值得的，是别人愤怒的对象”(吉尔伯特，2009c)。在CFT中，它试图阐明这些强大的情感体验，这些体验可以用经典的条件反射学习术语来描述，这是核心，而不是探索言语标签来体验。因此，CFT治疗师会询问当这个人第一次这样看待自己时是什么时候，以及当她以这种方式谈论自己时脑海中浮现出的早期场景。

然而，重要的是，ACT是最著名的探索我们的新进化出的认知能力（符号化、心理化、形成自我认同以及将自我作为背景）在决定我们易患心理健康问题的脆弱性方面的疗法。ACT以同情的故事重构这些重要的进化适应，这是创新的，特里奇、舍恩多夫和西尔伯斯坦提供了很好的指导。

Foreword The last ten years have seen a proliferation of interest in the scientific study of compassion. Given that Buddhism argued that the cultivation of compassion is central to the well-­being of self and others over 2,500 years ago, some would say “about time”! Yet when William Tuke established one of the first therapeutic communities at the York Retreat in 1796, he purposely tried to create a compas- sionate, supportive environment. The medical historian Roy Porter (2002) says “Tuke’s grandson Samuel noted that medical therapies had initially been tried there with little success; the Retreat had then abandoned ‘medical’ for ‘moral’ means, kindness, mildness, reason, and humanity, all within a family atmosphere—­with excellent results” (p. 104). However, until recently, compassion has not fared well as a scientific focus in psychotherapy. Although Carl Rogers identified core ingredients of the ther- apeutic relationship based on empathy and positive regard, the idea of the “com- passionate therapeutic relationship” was always rather vague, while the deliberate cultivation of compassion for self and others in our clients as a therapeutic aim is entirely new (Gilbert, 2009a, 2010). The early psychodynamic formulations of Freudians focused on the darker side of humanity—­sexuality and violence—­ and compassion was but a sublimation of these (Kriegman 1990, 2000). Behaviorists were interested in exposure to what we fear, and cognitive thera- pies were keen to help us our address our irrational thinking. Today, however, psychotherapists are beginning to look anew at the concept of compassion and its therapeutic potential. Part of this is because compassion has gained scientific acceptability. This was especially inspired by neuroscientists working with the Dalai Lama and studying what happens in the brain when people practice compassion (Lutz, Brefczynski-­Lewis, Johnstone, & Davidson, 2008). A second major impetus for the integration of compassion in therapy has come from the increasing recognition of the evolved nature and importance of attachment, which is rooted in competencies for parents to be sensitive to the distress of their infants and have the ability to respond to that stress, and for infants to be responsive to that care (Mikulincer & Shaver, 2007b). A third influence is the growing evidence that prosocial behavior, affec- tion, affiliation, and a sense of belonging and connectedness with others all have major impacts on mental well-­being (Cacioppo & Patrick, 2008) and on many physiological processes (Cozolino, 2007), including genetic expression (Slavich & Cole, 2013). In fact, there is good evidence now to suggest that humans function at their best when they feel valued, loved, and cared for, and when they in turn can be valuing and caring of others (Gilbert & Choden, 2013). So affiliative relationships are the center of well-­being, and it’s rather surprising that psychotherapists have been so slow in looking at the processes by which affiliative emotion is created, is shared, and heals. Against this growing research interest in affiliative, prosocial, and compas- sionate behavior, many therapies now are beginning to think about the nature and therapeutic potential of compassion. It is therefore timely that acceptance and commitment therapy (ACT), as one of the major new schools of psycho- therapy, is also beginning to consider the nature and value of compassion within its own context. ACT has always seen the therapeutic relationship as central to the therapeutic journey (Pierson & Hayes, 2007), but it is comparatively recently that compassion itself has become a focus of interest. So, what better guides to have for the ACT therapist to begin the journey into compassion than Drs. Dennis Tirch, Laura Silberstein, and Benjamin Schoendorff? Dr. Tirch not only is an experienced and world-­recognized ACT therapist, he has trained in compassion-­focused therapy (CFT; Gilbert 2009a, 2010) and been involved with Buddhist practice for many, many years. He has established The Compassionate Mind Foundation USA (http://www.compassionfocusedtherapy .com) and The Center for Mindfulness and CFT (http://www.mindfulcompas sion.com), both of which seek to further training, research, and development of CFT in North America. Dr. Schoendorff is an internationally known expert in and trainer of ACT and functional analytic psychotherapy (FAP) who empha- sizes training self-compassion in the psychotherapeutic relationship. Dr. Silberstein is an expert in the role of emotions in psychological flexibility and has been researching, practicing, and writing about the integration of CFT, Buddhist psychology, and ACT throughout her career. These authors bring unique schol- arship and wisdom to offer important insights into the different models of ACT, FAP, CFT, and more, with rich and innovative ideas on how these approaches can be integrated in bringing compassion into therapeutic focus. Compassion is easily misunderstood and confused with love and kindness. In fact, the hardest but most powerful forms of compassion are for things we neither love nor like, and this includes such things in ourselves. In the Mahayana Buddhist tradition, for which the Dalai Lama is one of the most powerful advo- cates, the core of compassion is motivation—­the motivation to be of benefit to others—­called bodhicitta. This motivation is to cultivate one’s ability to be sen- sitive and attentionally and emotionally attuned to the suffering in self and others, able to see into its causes and to acquire the wisdom and commitment to try to alleviate and prevent it. Captured here is obviously the motivation to turn toward suffering, into its wind, rather than away from it; to cultivate a willingness to engage with suffering and its causes. Here we see an immediate resonance with ACT, which since its inception has focused so elegantly on the issue of emotional avoidance and on creating a willingness to experience things as they are. More importantly, however, in both CFT and ACT, compassion is made a therapeutic focus not just for the relief of suffering but for the promotion of well-­being. This is partly why CFT pays a lot of attention to the underlying dynamics of attachment and affiliative behavior. Compassion as a therapeutic focus must be about promoting well-­being, not just reducing suffering. While CFT has sought to illuminate some of the key constituents of compassion—­such as care-­focused motivation, attentional sensitivity, sympa- thy, distress tolerance, empathy, and nonjudgment—­and to help people culti- vate these attributes, ACT has focused more on principles of liberating people from the tangles the mind can weave. These tangles arise because in addition to basic motives and emotions that we share with other animals, about 2 million years ago humans evolved capacities for imagination, rumination, a sense of self, and self-­monitoring. The way these newly evolved cognitive competencies integrate and fuse with older emotion motivational systems is a central concern for ACT. Essential to helping people disengage from aversive self-­monitoring and self-­labeling that have become fused with painful emotions is the cultiva- tion of what ACT calls psychological flexibility. Like compassion, this concept is not a straightforward one; it is really an outcome of a number of sub-­processes such as defusion, values, self-­as-­context, acceptance, committed action, and mindfulness. So Tirch, Schoendorff, and Silberstein set themselves the task of consider- ing how the different processes of compassion and psychological flexibility relate to each other and how each can be considered from the other’s perspective. The aim is not to collapse one model into another but to illuminate how ACT can address the phenomenology of compassion in its own terms. The result is an innovative and thought-­provoking narrative on new ways of cultivating com- passion, or at least creating the conditions for it to arise. So if ACT practitioners want to think about how they can bring compassion center ground in ACT terms, here is a way of doing so. CFT suggests that the healing qualities of compassion are rooted in particu- lar states of mind that recruit core physiological systems that evolved in part alongside attachment, altruism, and caring behavior (Gilbert, 2009a)—­oxytocin and the myelinated vagus nerve of the parasympathetic nervous system being two such systems. So CFT involves breath training, mindfulness, imagery, and body-­focusing work. CFT also uses method acting techniques to practice acting as if…, and imagining oneself to be a compassionate person (Gilbert, 2010), which help clients to build a self-­identity around the core attributes of compassion. This sense of self then becomes the focus—­the secure base and safe haven, to use attachment terms—­from which we can engage with suffering. ACT derives its theoretical nutrients from behavioral research, and it does not call on attachment theory or focus on any specific underlying physiological mechanisms that may create a calmer, wiser, more affiliative mind. Although ACT also sees compassion as rooted in ancient evolved systems of mind, it places its evolutionary emphasis on cooperation, rather than caring. For ACT, the advantages of cooperation created evolutionary pressures that enhanced human beings’ abilities to cooperate. Obvious ones were verbal communication and languages open to the use of symbols as representations of the world. So, words and symbols became signifiers that allowed people to share knowledge, concepts, and learning. But none of that could arise without people having a fundamental interest in each other and a desire to share, as well as to take some joy in the sharing. In ACT it was the evolution of human language and the symbolic and verbal representations it enabled that opened the door to fusion; that is to say, symbolic and verbal representations could become fused with a person’s sense of self. By contrast, a monkey that experienced threat from a dominant and responded submissively would not have the linguistic or symbolic capacity to begin to think of itself as inferior and subordinate or consider the consequences of that experience for its life and relationships with other monkeys—­indeed, it wouldn’t have a sense of self in this sense. So as you will see, this book has a lot of focus on the concept of verbal labeling, since that is an ability unique to humans. This is not unimportant in CFT, but less important, because CFT is more focused on direct experience and would be interested in the “emotional scenes in the mind” and the emotional memories associated with feelings of inferior- ity, rather than their verbal labeling. For instance, in the case of shame: If a parent is angry with a child, the child lays down memories of self (conditioned emotional learning) as stimulating anger in others. This is coded as an “emo- tional scene,” and such emotional scenes become the basis for subsequent self-­ definition. So an individual who has experienced anger from a parent (and may also have verbally labeled them as inadequate or bad) may talk about feeling inadequate or vulnerable to criticism. But actually the key is they are indicating that “In my emotional memory, I have experienced myself as inad- equate and as the target of others’ anger” (Gilbert, 2009c). In CFT, it is trying to illuminate these powerful emotional experiences, which can be seen in clas- sical conditioning learning terms, that is central, rather than exploring verbal labels to experience. So a CFT practitioner would inquire when that individual first thought of herself like that and what early scenes come to mind when she talks about herself in that way. Importantly, however, ACT is the most prominent therapy exploring the way our newly evolved cognitive competencies for symbolization, mentalizing, developing a self-­identity, and having the self-­as-­context play significant roles in determining our vulnerability to mental health difficulties. The way ACT cho- reographs these important evolutionary adaptations in the human line in a story of compassion is innovative, and again, Tirch, Schoendorff, and Silberstein provide excellent guidance. These authors offer many clinical examples which helpfully guide the ACT therapist and also offer important points of contrast between ACT and CFT. For example, in CFT, shame and self-­criticism are seen to be at the root of many psychological difficulties, but they in turn are rooted in real and feared experi- ences of social loss and rejection. Behind self-­criticism are the fears of the abused, marginalized, and forgotten, and fueling them are painful emotional memories. Indeed, CFT was partly born out of efforts to work with these ways of thinking and feeling about oneself. CFT notes that Freud had two basic theo- ries of self-­criticism. One was that self-­criticism arose from the internalization of the critical voice of the parent, sometimes referred to as superego prohibi- tion. The other was that it was anger turned inward, whereby people became critical of themselves rather than directing anger towards others whom they needed in some way. The treatment of these may be quite different, with the latter requiring some engagement with repressed and avoided rage (Busch, 2009); but for each case, the fear of giving up self-­criticism is central (Tierney & Fox, 2010). Indeed, many therapies now have their ways of working with self-­criticism because it’s potentially so disruptive to well-­being (Kannan & Levitt, 2013). In CFT we develop compassion to develop the courage to engage with the difficult stuff, which includes some of the darker aspects of our minds. Indeed, CFT suggests that the emotions that don’t turn up in the therapy can be ones the client is frightened of, and the ones that require the most work. For example, a depressed person might be quite confident in talking about his sadness and sense of loss but not about the rage he feels for the parent who failed to protect him or love him as he needed or wanted. Similarly, the angry person may be quite happy to rage about the world but entirely out of touch with the sense of loss and loneliness that hides real grief and pain. ACT thera- pists will be very familiar with experiential avoidance and the idea that one emotion can be a safety strategy to hide another emotion. The ACT therapist treating the angry person might ask “I see you are angry right now, but if I was to peel back the anger, what might I see behind it?” (Robyn Walser, personal communication, 2012). However, when exploring self-­criticism, ACT also places a central focus on the verbal construction of experience. Time and again in the clinical anecdotes we see this focusing on verbal representations. As the authors of this book write, “Understanding the verbal processes that lie at the root of self-­hatred and rein- force it can help clinicians devise targeted interventions that can gradually undermine self-­critical behavior and foster a more compassionate approach to how hard it is to live in this world” (p. 91). This makes it clear how ACT sees “verbal experience” and labeling as being at the root of self-­hatred. In ACT, we verbally create representations of ourselves out of the experiences that we have had; ACT focuses on the words people use to describe their experience.

Meanwhile, CFT would focus on in-­the-­body experience, the actual memories that created this experience, and fear of changing an identity of being a shame- ful, self-­critical person. In some of the later clinical chapters, the authors draw heavily from the CFT approach, offering ACT practitioners many new ways of creating compassion and utilizing its therapeutic potential. Central there is the fact that the “compassionate self” CFT encourages individuals to build helps them access the inner courage and wisdom necessary to begin to work with dif- ficult aspects of the mind, be they anger, anxiety, or trauma. This book shows how ACT practitioners can bring their own unique version of compassion into the therapeutic process, even to the degree that it can become a core value. At some point, of course, we will need to do further research to see how different models of compassion and their therapeutic strate- gies compare. But for the moment, endeavors to understand and cultivate com- passion are vitally important. This is not just because we desperately need better ways to understand and help those seeking our support but because compassion is crucial to the creation of a better world. The more deeply we understand compassion and how to cultivate it in our schools, businesses, and politics, the greater the chance is that those yet to be born will arrive in a fairer, more just, and caring world. Tirch, Schoendorff, and Silberstein offer us a fascinating and remarkable book to help us on that journey. They’ve written the book in a spirit of real encouragement and enthusiasm for the potential of improving our thera- pies. As such, it makes a significant contribution to the ongoing journey to understand and find ways to better help patients. —­Paul Gilbert, PhD, FBPsS, OBE